Myth #17

The Defects Of National Health Insurance Schemes In Other
Countries Could Be Remedied By A Few Reforms.

The characteristics
described above are not accidental by-products of government-run health care
systems. They are the natural and inevitable consequences of politicizing
medical practice.

Why are low-income and
elderly patients so frequently discriminated against under national health
insurance? Because such insurance is always and everywhere a middle-class
phenomenon. Prior to its introduction, every country had some government-funded
program to meet the health care needs of the poor. The middle-class working
population not only paid for its own health care but also paid taxes to fund
health care for the poor. National health insurance extends the "free ride" to
those who pay taxes to support it. Such systems respond to the political demands
of the middle-class working population, and they serve the interests of this
population.

Why do national health
insurance schemes skimp on expensive services to the seriously ill while
providing so many inexpensive services to those who are only marginally ill?
Because the latter services benefit millions of people (read: millions of
voters), while acute and intensive care services concentrate large amounts of
money on a handful of patients (read: small number of voters). Democratic
political pressures in this case dictate the redistribution of resources from
the few to the many.

Why are sensitive rationing
decisions and other issues of hospital management left to hospital
bureaucracies? Because the alternative is politically impossible. As a practical
matter, no government can make it a national policy that 9,000 people will die
every year because they will be denied treatment for chronic kidney failure. Nor
can any government announce that some people must wait for surgery so that the
elderly can use hospitals as nursing homes, or that elderly patients must be
moved so that surgery can proceed.

These decisions are so
emotionally loaded that no elected official can afford to claim responsibility
for them. Important decisions on who will and will not receive care and on haw
that care will be delivered are left to the hospital bureaucracy because no
other course is politically possible.